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Renal system > Anatomy of Kidneys and Ureters > Flashcards

Anatomy of Kidneys and Ureters Flashcards

1
Q

what do the ureters do?

A

allow passage of urine from kidneys to bladder

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2
Q

where is the bladder located?

A

pelvis

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3
Q

what are the functions of the urinary system?

A 
regulation of fluid/ blood volume
regulation of osmolarity
regulation of ion concentrations
regulation of pH
production of hormones for BP regulation and production of RBCs
vitamin D metabolism pathway
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4
Q

what is normal GFR?

A

125ml/min of blood

180L/day

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5
Q

what is normal urine volume?

A

1L/day

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6
Q

what does the kidney receive?

A

25% of cardiac output

consumes 7% of oxygen

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7
Q

length of kidney

A

10-13cm

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8
Q

Where are the kidneys located?

A

retroperitoneal
upper posterior abdomen
in extraperitoneal connective tissue
lateral to vertebral column

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9
Q

what does retroperitoneal mean?

A

lie behind the peritoneum

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10
Q

what is the peritoneum?

A

lining of the abdo cavity

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11
Q

supine location of kidney

A

T12-L3

right kidney is lower than left due to liver

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12
Q

difference between the 2 kidneys

A

left is longer and slimer than right

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13
Q

what causes alterations in the location of the kidneys?

A

respiration and body position

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14
Q

what happens to the kidney position in respiration?

A

kidneys closely associated with diaphragm so when it contracts
on inspiration they move inferiorly - 2.5cm

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15
Q

renal hilum location

A

located at L1 - 5cm from midline

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16
Q

rib levels of kidneys

A

left reaches rib 11 but right only 12

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17
Q

L1

A

transpyloric plane

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18
Q

where are the lower poles of the kidneys

A

L3-4

on right few cm superior to iliac crest

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19
Q

clinical examination of kidneys

A

not dull to percussion due to overlying colon
bimanually between 2 palpating hands - balloting
normally impalpable
when kidney can be felt (especially left) may indicate pathology

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20
Q

what are the surfaces of the kidney?

A

anterior and posterior surfaces

inferior and superior poles

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21
Q

what is the hilum of the kidney?

A

structures run from and to the kidney through here
on anteromedial side
vertical cleft entrance

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22
Q

kidney sinus

A

space within kidney, runs past hilum

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23
Q

what is in the sinus of the kidney?

A 
pelvis
calices
vessels
nerves 
fat
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24
Q

what enters and leaves through the renal hilum?

A

renal vessels
lymphatics
nerves
ureter

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25
Q

what covers the kidney

A

smooth surface covered by fibrous capsule - easily removable

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26
Q

what makes up the internal structure of the kidney?

A

cortex and medulla

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27
Q

what is the renal cortex?

A

continuous band of pale tissue that surrounds the medulla

has extensions that project into the medulla, dividing it into segments - renal pyramids

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28
Q

renal pyramids

A

bases face the medulla and tips project inwards

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29
Q

what surrounds the renal pyramids?

A

minor calyx

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30
Q

minor calyx

A

fuse to form major calyx

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31
Q

major calyx

A

unite to form renal pelvis

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32
Q

what is the renal pelvis?

A

funnel shaped superior end of ureter

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33
Q

where is the renal sinus located in relation to renal hilum

A

deep to it

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34
Q

which structures are retroperitoneal

A 
suprarenal - adrenal glands
aorta/ inferior vena cava
dueodenum
pancreas - except tail
ureters
colon
kidneys
oesophagus
rectum

Mnemonic = sadpucker

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35
Q

what is found anterior to the right kidney

A 
adrenal gland - superior
liver
2nd part of dudenum
right colic flexure
ascending colon
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36
Q

what is found anterior to the left kidney?

A 
adrenal gland - superior
stomach
spleen
pancreas
jejunum
left colic flexure
descending colon
37
Q

what separates structures from the kidney

A

some are separated by layer of peritoneum

some are directly against the kidney

38
Q

hepatorenal recess

A

on the right

place where intra-abdo fluid can collect

39
Q

lienorenal ligament

A

on left
mesenteric fold
contains splenic vessels

40
Q

where do the kidneys lie?

A

on top of the posterior abdominal wall muscles

41
Q

what is found posterior to the kidneys?

A 
diaphragm 
costodiaphragmatic recesses
posterior abdo wall muscles 
transversus abdominis
nerves
42
Q

what are the posterior abdo wall muscles?

A

psoas and quadratus

43
Q

what nerves pass posterior to the kidney?

A

subcostal vessels and nerves of 12th ribs
iliohypogastric
ilioinguinal

44
Q

how many layers surround the kidney?

A

4

45
Q

what are the layers that surround the kidney?

A

renal capsule
perinephric fat
renal fascia
paranephric fat

46
Q

renal capsule

A

attached to kidney itself

47
Q

perinephric fat

A

extends into renal sinus
surrounding renal capsule
protects

48
Q

renal fascia

A

encloses kidneys and adrenal glands
separates perinephric and paranephric fat
another fascia layer within this separates the adrenal gland and kidneys

49
Q

what is the blood supply to the kidneys?

A

renal arteries which branch from the abdominal aorta

50
Q

what level do the kidney arteries branch from the aorta?

A

L1
left slightly higher than right
just below origin of superior mesenteric artery

51
Q

accessory arteries

A

30% population
come into kidneys outside of hilum - extrahilar insertions
from more inferior along aorta or along iliac artery

52
Q

branches of the renal artery

A

splits into 5 when enters the kidney

53
Q

what are the vascular segments of the kidney?

A 
apical/ superior
caudal/ inferior
upper anterior
middle anterior
posterior
no collateral circulation between them
54
Q

benefit of vascular segments

A

surgically resectable

55
Q

right and left renal arteries

A

right renal artery longer and passes posterior to inferior vena cava
left renal vein longer than right

56
Q

renal veins

A

multiple renal veins fuse together to form the left and right renal veins
communicate across segments

57
Q

location of renal arteries and veins

A

arteries are posterior to veins

58
Q

left renal vein

A

longer
crosses midline anterior to abdominal aorta and posterior to superior mesenteric artery
risk of compression

59
Q

what does the left renal vein drain

A

left gonadal vein
left suprarenal vein
but on the right they drain directly into IVC

60
Q

compression of left renal vein

A

caused by lymphodenopathy
aortic aneurysm
etc.
causes varicocele

61
Q

what is the lymphatic drainage to the kidney?

A

lateral aortic lumbar nodes
para caval
para aortic nodes
follows venous drainage

62
Q

what is the innervation of the kidneys?

A

parasympathetic and sympathetic
celiac and intermesenteric plexuses
splanchnic nerves
pain fibres from ureteric pelvis

63
Q

structure of renal hilum

A

front to back:
vein
artery
pelvis of ureter

64
Q

what does the renal pelvis receive?

A

each one receives 2 or 3 major calyces
each major calyces receives 2 or 3 minor calyces
usually all collapsed

65
Q

what happens when there is abnormal distension of calyces

A

hydronephrosis
minor calyces losse concave shape
renal pelvis distended

66
Q

transpyloric plane

A

imaginary line
halfway between suprasternal notch and pubic symphysis
L1

67
Q

what does the transplyoric plane pass through

A 
9th costal cartilage
end of spinal cord
2nd part of duodenum
neck of pancreas
fundus of gall bladder
sphincter of oddi
lower border of spleen
superior mesenteric artery
origin of portal vein
68
Q

what are the ureters?

A

muscular tubes that transport urine from kidneys to bladder

69
Q

what lines the ureters

A

transitional epithelium

70
Q

what lines the bladder?

A

transitional epithelium

71
Q

course of ureters

A

25cm long from renal pelvis to entrance of bladder at ischial spine
retroperitoneal course in line with transverse porcesses
medial to psoas muscle

72
Q

where do the ureters enter the pelvis?

A

bifurcation of common iliacs
in front of sacroiliac joint
runs on lateral wall of pelvis in front of internal iliac artery

73
Q

ureter from renal pelvis

A

ureteropelvic junction

74
Q

ureters in females

A

ureters pierce the cardinal and broad ligaments of uterus

75
Q

what structures are anterior to the ureters?

A

ovarian/ testicular vessels
right colic vessels and ileocolic vessels
left colic vessels
uterine vessels

76
Q

what structures are posterior the the ureters?

A

psoas major

common iliac artery bifurcation - internal iliac

77
Q

where are the constrictions of the ureters?

A

where the ureters leave the kidney - ureteropelvic junction
where ureters cross common iliac vessels at the pelvic brim
where the ureters enter the bladder

78
Q

what is the clinical relevance of constrictions of the ureters

A

where calcifications/ calculus or blood clots can get stuck

79
Q

blood supply to ureters

A

multiple arteries as it descends:
1. aorta
2. renal arteries
3. gonadal (ovarian/ testicular) arteries
4. common and internal iliacs
5. inferior vesicle artery - branch of internal iliac, supplies part of bladder as well
form a longitudinal anastomosis

80
Q

venous drainage of ureters

A

renal and gonadal veins

81
Q

water under the bridge

A

ureter passes under uterine artery which can be potentially injured at ligation of the artery for hysterectomy

82
Q

where can the ureter be damaged?

A

pelvic brim
hysterctomy - uterine artery
vesical uretero junction during C section

83
Q

lymphatic drainage of ureters

A

follows arterial supply
lateral aortic lumbar nodes
common iliac vessel nodes
external and internal iliac vessel nodes

84
Q

loin to groin pain

A

classic ureteroteric pain

comes and goes

85
Q

motor innervation of ureters

A

visceral efferent fibres from sympathetic and parasympathetic sources

86
Q

sensory innervation of ureters

A

visceral afferent fibres of ureter return to T11 and L2 spinal cord level

87
Q

where is ureteric pain felt?

A 
loin to groin regions
cutaneous areas supplied by T11-L2
posterior and lateral abdo wall 
pubic region
scrotum or labia majora
proximal anterior aspect of thigh
88
Q

what causes ureteric pain?

A

obstruction and or distension of ureter

from renal colic

89
Q

nephrostomy

A

drains urine from kidney if ureters are blocked

Renal system (17 decks)

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